Health of the Health Workforce

The health of the health workforce

The Health of the Health Workforce 2013 to 2014 is the first of what will be yearly reports on the state of the New Zealand health and disability workforce – hereafter referred to as the workforce. It is one of two reports that Health Workforce New Zealand (HWNZ) is publishing in 2014.
You can find out more about HWNZ in the companion report The Role of Health Workforce New Zealand.

Data sources

Evidence from a variety of sources contributes to HWNZ’s ability to synthesise information about the workforce and the environment it operates in, and from there to identify trends.
The data and workforce intelligence cited in these reports are drawn from multiple sources; for example, regulatory bodies such as the Medical Council of New Zealand (MCNZ) and Nursing Council of New Zealand (NCNZ), the wider Ministry of Health, district health boards (DHBs) and other employers, OECD reports, the New Zealand Census and Workforce Service Forecasts commissioned by HWNZ.
Because of this, there is some variation in the date ranges of the workforce data used.

General workforce facts and figures

The workforce is made up of a wide variety of occupational groups, ranging from highly trained health professionals to care and support workers with limited qualifications. The five main occupational groups discussed in this report are:

doctors and dentists – the medical workforce

nurses

midwives

allied health, science and technical workers

non-regulated workers – also collectively termed kaiāwhina.

Doctors, dentists, nurses, midwives and a number of allied health professions are covered by the Health Practitioners Competence Assurance (HPCA) Act 2003, and are together referred to as the regulated workforce. Practitioners must be registered with the relevant regulatory body that issues annual practising certificates, considers complaints and takes disciplinary action when needed. The regulated workforce numbered 94,613 as of 31 March 2013, based on annual practising certificate data for all regulated professions.
District health boards are a key employer, with estimated Employed Full-Time Equivalent (FTE) workforces in March 2014 (and November 2008) of:¹

7518 (5930) doctors

20,719 (17,523) nurses

879 (801) midwives.

About one-third of New Zealand’s estimated 63,000-strong non-regulated workforce is employed by residential care providers.

Doctors

The medical workforce has grown by 15.2 percent in the past five years. There are currently 14,395 doctors with annual practising certificates registered with the MCNZ, up from 12,493 in 2009.²
Some critical shortages remain in particular specialties. The following are signalled as hard-to-staff for 2015’s Voluntary Bonding Scheme (VBS): general practice, general surgery, internal medicine, pathology, psychiatry and rural hospital medicine. General practice continues to be an area of particular need, especially in certain rural and provincial areas. The VBS also records hard-to-staff regions year by year – see the map on page 3.
The Voluntary Bonding Scheme rewards medical, nursing and midwifery graduates who work in hard-to-staff specialties or communities for three to five postgraduate years. Medical physicists, sonographers and radiation therapists working in New Zealand are also eligible. More information is available at www.health.govt.nz
The medical workforce is ageing. Almost 40 percent of doctors are currently aged 50 or over, up from 34 percent in 2009. Five years ago, the largest group of doctors was aged between 45 and 49. Since 2011, the largest age group has been 50- to 54-year-olds. However, an ageing medical workforce is an international trend, and New Zealand is better placed than many other OECD countries in terms of the number of doctors in the workforce aged 55 years and over.
Figure 1: Percentage of doctors aged 55+ in 28 OECD countries, 2000 and 2011³


The gender gap in New Zealand’s medical workforce is closing. Women make up 41.3 percent of the workforce (39.1 percent in 2009) and outnumber men among new doctors. Further:

45 percent of female doctors are under 40 years of age

28 percent of male doctors are under 40 years of age

58 percent of house officers⁴ and 49 percent of registrars⁵ are women.

Māori and Pacific peoples remain under-represented in the medical workforce. However, recent

increases in the numbers of medical students from both groups indicate an emerging generation of Māori and Pacific doctors.⁶

There are 69 GPs per 100,000 New Zealanders, up from 58 in 2009. Auckland, Capital & Coast and Nelson Marlborough DHBs have the highest numbers of GPs per head of population (100+), while West Coast, MidCentral and Counties Manukau have the lowest (37 to 51). See Appendix 1 for numbers of all specialists per 100,000 population.
Demand for GPs will only continue to rise as models of care move out of hospitals and into the community. However, the proportion of GPs in the specialist workforce continues to track slowly downwards, from 38.3 percent in 2007 to 37.5 percent in 2009 and 37.4 percent in mid-2014. Compounding this, the trend is for GPs to work shorter hours. MCNZ’s 2012 workforce survey – the latest available – showed that GPs worked on average 37.3 hours a week (0.93 FTE based on a 40-hour week), down from 40+ a decade ago. The average across all specialities was 43.1 hours a week.
Numbers of non-GP specialists continue to grow at a faster rate than GPs – see Figure 3. Between mid-2009 and mid-2014, MCNZ figures show the number of GPs with annual practising certificates went up by 24.5 percent (2509 to 3124).⁷ The number of non-GP specialists increased by 25.3 percent over the same time, up from 4176 to 5234.
Figure 2: Hard-to-staff communities for doctors and GP trainees on the 2015 Voluntary Bonding Scheme


Figure 3: Trends in numbers of GPs and non-GP specialists⁸


To help trainee doctors make informed decisions when choosing a specialty, HWNZ is modelling the medical workforce pipeline from graduation through to specialist training. This is a key aim of the Medical Workforce Taskforce. See our companion report, The Role of Health Workforce New Zealand, for more information.
Table 1: Medical workforce statistics

Medical workforce*
Size^+	Age 50+^+	Gender split	Ethnicity	Workplace^	Qualified outside New Zealand
14,395 (including 3124 GPs)	38.9%	Female 41.4% Male 58.6%	European 95.3% Māori 2.9% Pacific 1.8%	Public 54.4% Private 29% Other 16.6%	43.4%^+

* Figures from MCNZ 2012 workforce survey, unless otherwise stated.

+ Annual practising certificates as of mid-2014.

^ Main place of employment.
Appendix 2 contains a graph showing each specialty’s ratio of postgraduate vocational trainees to specialists – and the average age of these senior doctors – to show which specialties are the most vulnerable to future shortages of senior staff.
Analysis so far indicates that graduate doctors who choose to train in certain specialties, including palliative medicine, rehabilitation and dermatology, are likely to have better job prospects. This is because the ratios of trainees to specialists are relatively low, and the average age of these senior doctors is 50+ years.
Job prospects are also good for doctors choosing to train as GPs. There is a high demand for GPs and a relatively low ratio of trainees to senior staff. General practice presents a doctor with the challenge of working with a wide variety of patients and being the first point of care. The hours tend to be more regular compared with other specialties, and there is greater scope for working part-time.
New Zealand continues to employ overseas-trained doctors to address staff shortages. Such doctors accounted for 43.4 percent of the medical workforce as of mid-2014, up from 42.8 percent in 2010 and 41.2 percent in 2007.
The increase in this figure is in part due to more overseas-trained doctors staying longer in New Zealand, particularly those from South Africa and Asian countries such as India, according to MCNZ analysis.
Doctors from North America and the United Kingdom are more likely to stay for a year or two, often alternating stints as a specialist locum with time off to travel. Just 35 percent of doctors from the United States and Canada are still in New Zealand one year after registration, compared with about 70 percent of those from Asia.
After two years, retention rates drop to 20 percent for North American doctors and 63 percent for those from Asian countries, and 10 percent and 45 percent respectively after eight years. For United Kingdom doctors, retention rates are 53 percent after one year, 30 percent after two years and 20 percent after eight years.
Retention rates for all overseas-trained doctors level out at about 30 percent four years after registration, with only gradual decreases thereafter – this was a consistent annual trend between 2000 and 2012, the period examined by the MCNZ in its report on its 2012 workforce survey.⁹
The New Zealand-trained medical workforce is being boosted by an additional 200 government-funded medical student places, phased in between 2010 and 2016.
This in turn means that more postgraduate year one (PGY1) employment positions are required in DHBs. In 2013, for the first time, there were more applicants than vacancies for such positions as the first graduates of a separate expansion in student numbers joined the workforce. HWNZ and DHBs ensured that all New Zealand Government-funded students who graduated in 2013 received offers of employment. The Medical Workforce Taskforce’s priority is to ensure this will continue to be the case.
While the Taskforce initially focused on the immediate postgraduate period, a whole-of-career perspective has now been adopted. The most important issue is the impact of a prolonged period of medical labour market shortages on the workloads, wellbeing and productivity of DHB-employed senior doctors.
Other areas under consideration, some of which are directly related, include the distribution, long- term retention and retirement intentions of doctors trained in New Zealand and overseas. Leadership opportunities in systems improvement and innovation, consistent with the In Good Hands report on clinical leadership,¹⁰ are another focus for the Taskforce.